The American Heart Association and the American College of Cardiology have released their first clinical practice guideline on acute pulmonary embolism (PE), a sudden and potentially life-threatening blood clot that blocks arteries in the lungs. Published today in Circulation and JACC, the guideline emphasizes early detection and prompt treatment, introducing a new Acute Pulmonary Embolism Clinical Category system to classify severity and guide treatment strategies.
Acute PE is part of venous thromboembolism (VTE) and can cause low oxygen levels, lung damage, and heart strain. According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, approximately 470,000 people are hospitalized with PE annually in the U.S., and about 1 in 5 high-risk patients die. The guideline, chaired by Dr. Mark A. Creager, provides a road map for clinicians to navigate advances in diagnosis and treatment.
The new Acute PE Clinical Categories classify patients into five categories (A-E) based on symptom severity and adverse outcome risk. Categories A and B include patients with no or mild symptoms who can often be discharged from the emergency department. Categories C-E include higher-risk patients requiring hospitalization or critical care. The guideline also outlines risk factors for acute PE, including recent surgery, trauma, prolonged immobility, pregnancy, obesity, cancer, thrombophilias, and age over 40.
For diagnosis, the guideline recommends D-dimer blood testing for patients with low to intermediate probability of PE. If D-dimer is elevated or clinical probability is high, computed tomography pulmonary angiography (CTPA) is the standard imaging test. For patients who cannot undergo CTPA, lung ventilation/perfusion scan is an alternative.
Treatment primarily involves anticoagulants, with direct oral anticoagulants (DOACs) like rivaroxaban and apixaban recommended over warfarin due to safety and reduced bleeding risk. DOACs are not recommended during pregnancy; low-molecular-weight heparin or unfractionated heparin are safe alternatives. For higher-risk categories, advanced treatments such as catheter-based clot removal or surgical embolectomy may be needed.
Follow-up care includes early follow-up within one week of discharge, a three-month visit to reassess anticoagulation duration, and long-term monitoring for chronic thromboembolic pulmonary disease (CTEPD). The guideline also addresses psychological health, physical activity, travel precautions, and contraception counseling for women of childbearing age.
The guideline was developed in collaboration with eight other healthcare organizations, including the American College of Emergency Physicians and the Society for Vascular Medicine. It is endorsed by the American College of Clinical Pharmacy, American College of Chest Physicians, and others. For more details, visit the American College of Cardiology or the American Heart Association.
